POS1563-PARE SELF-MANAGEMENT STRATEGIES FOR ADVERSE DRUG REACTIONS AS REPORTED BY TNF-ALPHA INHIBITOR USERS: AN OBSERVATIONAL STUDY
Authors: M. Ophoff, J. Van Lint, S. Tas, B. Van den Bemt, H. Vonkeman, F. Hoentjen, M. Nurmohamed, N. Jessurun
Journal: Annals of the Rheumatic Diseases (2022)

Background Self-management strategies of adverse drug reactions (ADRs) are outside the vision of healthcare professionals (HCPs). Nevertheless, patients consider this information as one of the most important domains regarding ADR information (1). Therefore, identifying these strategies is important for both HCPs and patients. Objectives To identify which self-management strategies are applied by patients with immune-mediated inflammatory diseases (IMIDs) who encountered injection site reactions, local/systemic infections, or skin reactions during the use of adalimumab or etanercept. Methods Data of the Dutch Biologic Monitor (DBM), a prospective cohort event monitoring system, was used. Patients using biologics for IMIDs were asked to fill out bimonthly questionnaires on biologic use and experienced ADRs including questions on applied self-management strategies in an open-ended text field. For this study we included patients who used adalimumab or etanercept and reported injection site reactions, infections or skin reactions with self-management strategies. Self-management strategies were identified with thematic-analysis of the open-ended text fields. Results We included 160 patients and the characteristics are presented in Table 1. Most patients experienced injection site reactions (n=149), followed by infections (n=133), and skin reactions (n=101). Of these patients, the lowest number of applied self-management strategies was reported for injection site reactions (n=42, 28%), followed by skin reactions (n=62, 61%), and infections (n=88, 66%). The self-management strategies included themes such as ‘Changing methods of administration’ for injection site reactions, ‘Change of personal care’ for skin reactions, and ‘Additional treatment for the ADR’ for infections. Figure 1 shows which items are covered by these themes. Table 1. Patient characteristics. Patient characteristics, n=160 n (% ) Gender Female 110 (68.8) Age (mean (SD)) 53.6 y (±14.8) Indication Psoriatic arthritis 33 (20.6) RA 74 (46.3) Crohn’s disease 17 (10.6) Ulcerative colitis 3 (1.9) Bechterew’s disease / axial SpA 23 (14.4) Other a and RA 2 (1.2) Other b 8 (5.0) bDMARD Adalimumab 84 (52.5) Etanercept 76 (47.5) Most frequently reported ADRs Injection site reactions (pain, pruritis, erythema) 85 (100) Infections 231 (100) Cystitis 25 (10.8) Infection susceptibility increased 24 (10.4) Nasopharyngitis 21 (9.1) Skin reactions 266 (100) Eczema 42 (15.8) Psoriasis 29 (10.9) Dry skin 25 (9.4) Note: n= number of patients, y= years, RA= rheumatoid arthritis, SpA= spondyloarthritis, bDMARD= biological disease-modifying antirheumatic drug a Rheumatoid arthritis-associated lung disease (n=1), systemic scleroderma (n=1) b Uveitis posterior and panuveitis (n=1), birdshot chorioretinopathy (n=1), hemochromatosis (n=1), hidradenitis suppurativa (n=1), juvenile idiopathic arthritis (n=1), psoriasis (n=1), Bechterew’s disease and RA (n=1), RA and Crohn’s disease (n=1). Figure 1. Applied self-management strategies divided in themes. ADR= adverse drug reaction, HCP= Healthcare professional, ISR= injection site reactions, INF= infections, SR= skin reactions. Conclusion This study shows that patients apply a wide range of self-management strategies for their ADRs. Further research should focus on the effectiveness of these actions and subsequently dissemination or (de)implementation of these strategies if deemed (in)effective. References [1]Kusch MKP, Haefeli WE, Seidling HM. How to meet patients’ individual needs for drug information - a scoping review. Patient preference and adherence [Internet]. 2018 [cited 2022 Jan 12];12:2339–55. Available from: https://pubmed.ncbi.nlm.nih.gov/30464421/ Disclosure of Interests Marlous Ophoff: None declared, Jette van Lint: None declared, Sander Tas Consultant of: Pfizer, GSK, Celgene, BMS, Sanofi, AstraZeneca, Bart van den Bemt Speakers bureau: UCB, Pfizer, Sanofi-Aventis, Galapagos, Amgen en Eli Lilly, Harald Vonkeman Speakers bureau: Amgen, BMS, Celgene, Galapagos, GSK, Janssen-Cilag, Lilly, Novartis, Pfizer, Roche, Sanofi-Genzyme, UCB, Grant/research support from: Abbvie, Sanofi-Genzyme, Frank Hoentjen Speakers bureau: Frank Hoentjen has served on advisory boards or as speaker for Abbvie, Janssen-Cilag, MSD, Takeda, Celltrion, Teva, Sandoz and Dr Falk, Consultant of: Celgene, Grant/research support from: Funding (Grants/Honoraria): Dr Falk, Janssen-Cilag, Abbvie, Takeda, Michael Nurmohamed Speakers bureau: Abbvie, Janssen, Celgene, Naomi Jessurun: None declared